Meng Yingtong, Zhang Tingting, Lu Siyu, Zhang Yan, Mao Yunwen, Ge Xiaohua
Cardiology Department II Ward I, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, People's Republic of China.
School of Nursing and Health Management, Shanghai University of Medicine & Health Science, Shanghai 201321, People's Republic of China.
Eur J Cardiovasc Nurs. 2025 May 28;24(4):618-628. doi: 10.1093/eurjcn/zvaf027.
Self-care and caregivers' contribution to self-care are vital for chronic heart failure (CHF) patients. Family resilience and mutuality are known protective factors for self-care. However, little is known about how family resilience and mutuality contribute to self-care among heart failure patient-caregiver dyads. This study aims to examine actor and partner effects of family resilience on self-care through mutuality among CHF patients and caregiver dyads.
In the cross-sectional study, 220 CHF patient-caregiver dyads (n = 440 participants) were enrolled. Family resilience, mutuality, self-care, and self-care contribution to CHF were assessed by self-report questionnaires. The Actor-Partner Interdependence Mediation Model analysis was used to identify the direct and indirect effects of family resilience on self-care through mutuality in CHF patient-caregiver dyads. Actor effects showed that caregivers' family resilience had a direct effect on their own self-care contribution [direct actor effect, B = 0.385; 95% confidence interval (CI), 0.263-0.506]. Caregivers' mutuality (indirect actor effect, B = 0.057; 95% CI, 0.004-0.111) and CHF patients' mutuality (indirect actor effect, B = 0.04; 95% CI, 0.010-0.103) mediated caregivers' family resilience and self-care contribution. Partner effect showed that caregivers' family resilience predicted CHF patients' self-care behaviour (direct partner effect, B = -0.334; 95% CI, -0.406 to -0.251). Chronic heart failure patients' family resilience had indirect effects on caregivers' contribution to self-care via patients' mutuality (indirect partner effect, B = 0.019; 95% CI, 0.001-0.066) and caregivers' mutuality (indirect partner effect, B = 0.025, 95% CI, 0.001-0.058).
The results demonstrated a reciprocal influence on self-care between CHF patients and their caregivers. Family resilience within these dyads has impacted not only their own self-care but also those of their caregivers, with mutuality playing a mediating role. These results provided empirical support for improving the patients' self-care behaviour and caregivers' contribution at the dyadic level.
Chinese Clinical Trial Registry: ChiCTR2200064561.
自我护理以及照顾者对自我护理的贡献对慢性心力衰竭（CHF）患者至关重要。家庭恢复力和相互性是已知的自我护理保护因素。然而，关于家庭恢复力和相互性如何在心力衰竭患者-照顾者二元组中促进自我护理，我们知之甚少。本研究旨在通过CHF患者和照顾者二元组中的相互性来检验家庭恢复力对自我护理的主效应和伴侣效应。
在这项横断面研究中，纳入了220个CHF患者-照顾者二元组（n = 440名参与者）。通过自我报告问卷评估家庭恢复力、相互性、自我护理以及自我护理对CHF的贡献。采用主效应-伴侣相互依赖中介模型分析来确定家庭恢复力通过CHF患者-照顾者二元组中的相互性对自我护理的直接和间接效应。主效应表明，照顾者的家庭恢复力对其自身的自我护理贡献有直接影响[直接主效应，B = 0.385；95%置信区间（CI），0.263 - 0.506]。照顾者的相互性（间接主效应，B = 0.057；95% CI，0.004 - 0.111）和CHF患者的相互性（间接主效应，B = 0.04；95% CI，0.010 - 0.103）介导了照顾者的家庭恢复力和自我护理贡献。伴侣效应表明，照顾者的家庭恢复力可预测CHF患者的自我护理行为（直接伴侣效应，B = -0.334；95% CI，-0.406至-0.251）。慢性心力衰竭患者的家庭恢复力通过患者的相互性（间接伴侣效应，B = 0.019；95% CI，0.001 - 0.066）和照顾者的相互性（间接伴侣效应，B = 0.025，95% CI，0.001 - 0.058）对照顾者的自我护理贡献有间接影响。
结果表明CHF患者及其照顾者在自我护理方面存在相互影响。这些二元组中的家庭恢复力不仅影响了他们自身的自我护理，也影响了照顾者的自我护理，相互性起到了中介作用。这些结果为在二元组层面改善患者的自我护理行为和照顾者的贡献提供了实证支持。
中国临床试验注册中心：ChiCTR2200064561
